A contemporary view of the human placenta

Our current knowledge of the human placenta is briefly reviewed. Particular stress is placed upon the considerable functional reserve capacity of the placenta, the unimportance of most visible abnormalities of the placenta, the lack of any evidence that the placenta ages during gestation and the lack of significance of placental weight. The effects on the placenta of infection and of maternal cigarette smoking are considered and the concept of placental insufficiency critically discussed. It is concluded that most cases of 'placental insufficiency' are, in reality, examples of maternal vascular insufficiency resulting from inadequate placentation during the early stages of pregnancy.     

A Comparative Study of the Percutaneous versus Intraoral Technique for Mental Nerve Block

Objective: Mental nerve block is frequently used to aid repair of facial lacerations; both percutaneous and intraoral approaches to blocking this nerve are used, but have never been compared. The authors compared the two techniques for pain of administration and effectiveness of anesthesia. Methods: A prospective, randomized, single-blind, crossover study was conducted using ten healthy volunteers aged 22 to 33 years. Patients having prior experience with mental nerve blocks, lidocaine allergy, active oral/facial infection, or previous facial fractures were excluded. Bilateral mental nerve blocks were done using intraoral technique on one side and percutaneous technique on the other. Both techniques were used by the same investigator and were carried out with 27-gauge needles and 2.5 mL of 2% buffered lidocaine at room temperature injected over 20 seconds. The oral mucosa was topically anesthetized with viscous lidocaine for 1 minute prior to intraoral injection. The orders of the blocks and sides of the face anesthetized were randomized. Subjective and objective pain (visual-analog scale), efficacy (anesthesia of lower lip), time to onset, and duration of anesthesia were evaluated. Results: The intraoral technique was subjectively less painful than the percutaneous approach in nine of ten subjects (p = 0.02). Scores on the visual-analog pain scale were significantly lower for the intraoral technique (p = 0.03). Intraoral injection produced lower-lip anesthesia in 10/10 subjects versus 7/10 for percutaneous (p = 0.25). Times to onset (approximately 1–2 minutes) and durations of anesthesia (approximately one hour) were similar for the two techniques. Conclusion: The intraoral approach to the mental nerve block with adjunctive topical anesthesia was subjectively and objectively less painful than the percutaneous approach without adjunctive anesthesia. While the intraoral approach had a greater efficacy of lower-lip anesthesia and a longer duration of action, these differences were not statistically significant.     

Effect of Medicaid payment levels on access to obstetrical care.

Across the nation, the number of providers serving pregnant Medicaid clients has dropped precipitously. In an effort to retain providers, in 1986 the Maryland Medicaid program tripled reimbursement fees for deliveries. This raised Medicaid payments for perinatal care to levels roughly comparable to those paid by private insurers. Providers' participation can be measured using two criteria: the total number of participating providers in a given country and the number of deliveries performed by targeted providers. The fee increase was associated with an overall stabilization in the number of providers performing deliveries. Providers performed slightly more deliveries after the fee increase, relative to predictions derived from statistical models. One-quarter of all providers increased their participation on a scale commensurate with the fee increase.     

Joint capsule matrix turnover in a rabbit model of chronic joint contractures: Correlation with human contractures.

To evaluate changes in matrix molecules of the joint capsule, the right knees of 24 skeletally mature female NZW rabbits were immobilized while the contralateral limb served as an unoperated control. The immobilization was discontinued at 8 weeks and the rabbits were divided among four groups (n = 6) based on the number of weeks the right knees were remobilized: 0, 8, 16, or 32. Three rabbits (six knees) that did not have operations provided normal control joint capsules. The mRNA levels for collagen types I, II, and III, and MMP-1 and -13 were significantly increased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. In contrast, the mRNA levels for TIMP-1, -2, and -3 were decreased in the joint capsules of the contracture knees in all groups when compared to normal and contralateral limb joint capsules. The mRNA levels for lumican and decorin were increased in the joint capsules of the contracture knees in all groups when compared to normal capsules. Many of the changes observed in this animal model are similar to those observed in human joint capsules from posttraumatic elbow contractures, supporting the value of this rabbit model.     

In vitro characterization of peptide-modified p(AAm-co-EG/AAc) IPN-coated titanium implants.

Interpenetrating polymer networks (IPNs) of poly(acrylamide-co-ethylene glycol/acrylic acid) [p(AAm-co-EG/AAc)] functionalized with an -Arg-Gly-Asp- containing peptide derived from rat bone sialoprotein [bsp-RGD(15)] were grafted to titanium implants in an effort to modulate osteoblast behavior in vitro. Surface characterization data were consistent with the presence of an IPN, and ligand density measurements established that the range of peptide density on the modified implants spanned three orders of magnitude (0.01-20 pmol/cm2). In vitro biological characterization of the modified implants employing the primary rat calvarial osteoblast (RCO) model resulted in the identification of a critical ligand density (0.01相似文献   

Cataract surgery takes longer in functionally monocular patients.

BACKGROUND AND OBJECTIVES: To determine differences in the amount of work involved in caring for functionally monocular patients who undergo cataract surgery compared with binocularly sighted patients. PATIENTS AND METHODS: This was a retrospective study that included 100 consecutive functionally monocular patients and 100 binocularly sighted control patients matched by age (+/-5 years) and date of surgery ( +/-1 year). Office records were reviewed to determine several measures of office and operating room work effort. RESULTS: There was no difference between groups in preoperative telephone calls (P = .136), postoperative telephone calls (P = .580), preoperative office visits (P = .875), postoperative office visits (P = .601), or the number of times surgery was scheduled (P = 1.00). Monocular patients required more time for surgery (37.4 minutes) than binocular patients (32.4 minutes) (P= .010). CONCLUSIONS: It takes longer to perform cataract surgery on functionally monocular patients than on binocularly sighted patients.